| NPI | 1346659075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95000814) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP95000814) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: CA 4151) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-02-13 |